Skinfinity - Consent Form : Botulinum Toxin

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Patient Guide to Botulinum Toxin

At consultation your non surgical practitioner will discuss with you:

Any relevant medical history.

Try to ascertain your expectations, determine your suitability for treatment and then discuss possible treatment options for you to consider.

Explain the treatment processes and any possible risks and complications. Provide post treatment advice.

Prior to treatment the Practitioner will photograph the area/s to be treated.

After Botulinum toxin treatment:

Do not rub or massage the treated area for 2 days after treatment. Avoid lying down or excessive bending for 4 hours after treatment. Avoid excess alcohol for 24 hours.

Avoid exercise for 48 hours.

Avoid steam rooms/saunas/facial massages or treatments for 1 week.

2 days after treatment you can help activate the Botulinum toxin by gently exercising the muscles that have been treated, i.e. frown and smile as frequently as possible.

Some patients experience slight discomfort around the treatment area for a short time following the treatment session. You may experience bruising around the site of treatment.This will usually settle within a day or two.

The results are not permanent and the duration will differ from patient to patient. The treatment normally takes 2-14 days to take effect.

Very rarely the following may happen:

Drooping of eyelid or eyebrow
Asymmetry of any facial expressions
An allergic reaction

Should you experience any of the above please contact the clinic: 0113 397 0980.

I do hope that you are happy with your treatment. Please remember however that the treatment should last for approximately 3 months. It is therefore advisable to make an appointment for further treatment in the next 3-4 months.

Please contact the clinic 10-14 days after treatment if you would like the effect of the Botulinum toxin to be reviewed by the doctor. Is it not possible to perform any corrections more than 14-21 days after the initial treatment.

Consent Form: Botulinum Toxin

Botulinum toxin reversibly relaxes muscles. It can be used to treat facial lines caused primarily by the action of facial muscles on the skin. Botulinum toxin will not effect deep skin creases due to skin thinning. The treatment is given by injections directly into the muscles of the face. The effects will usually become visible in 48 to 72 hours, and will often take 1-2 weeks to reach the maximum effect. A single treatment will usually last from 2 to 6 months.

Side effects of the treatment can include:

Pain at injection site and/or bruising
Tiredness and headache
Temporary drooping of the eye lids and visual blurring
Dryness of the skin, rash or itching
Allergic reaction
Infection
Unsatisfactory result needing additional treatment
Heavy/lowered eyelids/eyebrows
Swelling
Muscle weakness or difficulty swallowing

You should not have this treatment if:

You are pregnant
Breast feeding
Suffer from Myasthenia Gravis
Eaton-Lambert syndrome
Bleeding disorders
You have had previous adverse reactions to botulinum toxin

You must inform the doctor if:

You are on amino glycoside antibiotics
Had an anesthetic or muscle relaxants in the last 7 days
Any allergies
You are taking any medication
You have had facial treatments in the past, surgical or non-surgical

Consent for treatment:

COVID-19

Have you had a COVID-19 Vaccine in the last 2 weeks?
(Please tick as appropriate)

YesNo

Do you have a COVID-19 Vaccine booked for anytime in the next 3 weeks?
(Please tick as appropriate)

YesNo

I have had a full discussion regarding this treatment and have been given the opportunity to ask questions. All foreseeable risks of Botulinum toxin injections have been thoroughly explained to me and my questions regarding the treatment and its possible side effects have all been comprehensively answered.

I have been given adequate time to consider my decision to have treatment and now consent to being treated with botulinum toxin.

I understand that I will have photographs taken before and after my treatment of the area to be treated. In the event that Skinfinity use these pictures for marketing purposes, your identity will be concealed.

If you do not wish to have your photographs used for marketing purposes please tick here

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9 August 2022 11:56 BST

Skinfinity - Consent Form : Botulinum Toxin Uploaded by Private Services - private.services@livingcare.co.uk IP 217.168.249.171

9 August 2022 14:49 BST

Skinfinity Clinic - info@skinfinityclinic.co.uk added by Henry Aspden - private.services@livingcare.co.uk as a CC'd Recipient Ip: 217.168.249.171

9 August 2022 14:53 BST

Skinfinity Clinic - info@skinfinityclinic.co.uk added by Henry Aspden - private.services@livingcare.co.uk as a CC'd Recipient Ip: 217.168.249.171

9 August 2022 15:09 BST

Skinfinity Clinic - info@skinfinityclinic.co.uk added by Private Services - private.services@livingcare.co.uk as a CC'd Recipient Ip: 217.168.249.171